Clinical and immunological characteristics of acute viral infection-related encephalopathy
Objective To analyze the clinical and immunological characteristics of children with acute viral infection-related encephalopathy.Methods Case-control study.A retrospective analysis was conducted on the clinical data of children diagnosed with acute viral infection-related encephalopathy during hospitalization at the Children's Hospital,Capital Institute of Pediatrics from January 2020 to January 2023.According to the last follow-up modified Rankin scale(mRS)score,these children were divided into a good prognosis group(mRS score≤2)and a poor prognosis group(mRS score＞2),and the clinical and immunological characteristics of the children with different prognoses were analyzed.The binary Logistic regression was used to analyze the risk factors for poor prognosis.Results A total of 28 children with acute viral infection-related encephalopathy aged 4 months to 11 years were included.There were 16 males(57％)and 12 females(43％).Among the preinfection viruses,there were 16 children of Corona virus disease 2019,8 children of influenza A virus,3 children of influenza B virus,and 1 child of norovirus.Among them,there were 21 children with acute necrotizing encephalopathy,4 children with acute encephalopathy with biphasic seizures and late reduced diffusion,2 children with mild encephalitis with a reversible splenial lesion,and 1 child with hemorrhagic shock and encephalopathy syndrome.Among the first symptoms,24 children(85.7％)had consciousness disorders,23 children(82.1％)had seizures,17 children(60.7％)had speech disorders,11 children(39.3％)had involuntary movements,and 10 children(35.7％)had abnormal mental behavior.For the site of lesion,the cranial nuclear magnetic resonance imaging revealed 17 in the thalamus,10 in the brainstem,9 in the basal ganglia,8 in the cerebellar hemisphere,and 4 in the corpus callosum.In the last follow-up evaluation,17 children had a mRS score of＞2,and 11 children had a mRS score of ≤2.Univariate analysis showed that disturbance of consciousness,seizure cluster,brain stem lesion,absolute value of serum T lymphocytes,cerebrospinal fluid(CSF)protein,CSF cytokines[interleukin(IL)-1β,IL-6 and IL-8]were higher in the poor prognosis group than those in the good prognosis group.Multivariate Logistic regression analysis indicated that brain stem disease,CSF IL-1β and T lymphocyte absolute number were independent risk factors for poor prognosis.Conclusions Brain stem lesions,cerebrospinal fluid IL-1βand the absolute number of T lymphocytes have predictive value for the prognosis of acute viral infection-associated encephalopathy.The more severe the conditions,the lower the T lymphocytes,and the higher the cytokines in some cerebrospinal fluid.
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